COMBINED FOSCARNET-GANCICLOVIR TREATMENT FOR CYTOMEGALOVIRUS INFECTIONS AFTER ALLOGENEIC HEMATOPOIETIC STEM-CELL TRANSPLANTATION (HSCT)

Thirty two allogeneic bone marrow transplant (BMT) recipients, aged 16 -55 (median 35), with CMV antigenemia (=>5 positive cells) developing at a median interval from BMT of 49 days, were given combined treatmen t with foscarnet and gancyclovir for 15 days. Maintenance was given wi th foscarnet and,ganciclovir on alternate days for an additional 2 wee ks. 31/32 patients were on cyclosporin 30 on systemic antibiotics and 9 were on intravenous amphotericin Median laboratory values on day 1 a nd 15 of treatment were respectively creatinine 1.0-1.1 mg%; WBC 5.7-4 .1 x 10(9)/I; platelets 78 72 x 10(9)/I. All patients cleared CMV-anti genemia by day +15, though 5 reactivated on and 14 off maintenance: th e dose of foscarnet (but not ganciclovir) received in the first 15 day s was significantly lower in patients reactivating within 30 days (p=0 .0002). Six patients died, one with IP, one with multiorgan failure, a nd four with infections. Eighteen patients survive 119-1051 days post- transplant. The actuarial TRM at 1 year is 23%. This study shows that combined foscarnet-ganciclovir is one therapeutic option for allogenei c BMT recipients developing CMVAg-emia with a high number of CMVAg+ ce lls: treatment can be given together with cyclosporin and antibiotics with appropriate dose reductions; it produces prompt clearing of CMV i nfection, and may reduce transplant related mortality when compared to single agent therapy.